Dr. Ramón E. Miró, Ob/Gyn
Fellow American College of Obstetrics & Gynecology
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How many weeks/months am I?
Pregnancy is usually measure from the first day of your last period. There are 40 weeks in the average pregnancy, with the assumption that you conceived 2 weeks after your period started (you are only actually pregnant for the last 38 of the 40 weeks). When counting in months, start from the conception date, not the period date. So, if you are 10 weeks pregnant you got pregnant 8 weeks ago. If you did not get pregnant at the average time, your due date will be based on the measurements from your first ultrasound.
When should I tell people that I am pregnant?
This is a personal choice which depends on how you would feel about others knowing that you had a miscarriage, if this should occur. Unfortunately, about 15% of diagnosed pregnancies end in miscarriage. The good news is that 85% don’t. If the baby has a heartbeat after 8 weeks from the last period, the risk of miscarriage is less than 5%. After 12 weeks, the risk is less than 1%. Many patients choose to wait to tell others about the pregnancy based on these statistics.
What and how much should I eat during pregnancy?
We need an average of only 300 extra calories daily during pregnancy. The common “Eating for two” concept will result in excessive weight gain. Most women will lose only 15-20 pounds in the first few weeks postpartum, with the rest stored as fat, so weight gain of 20-30 pounds is ideal (0-5 pounds in the first 12 weeks, and 1⁄2 pound-1 pound a week after that). Eat small frequent meals to avoid heartburn and hypoglycemia. Eat what you enjoy, but make healthy choices and go easy on sugars and starches to prevent excessive weight gain and gestational diabetes. While there is no evidence of direct baby harm caused by eating hot dogs or other highly processed meats, we recommend making healthier choices except on rare occasions. Raw fish and meat can carry parasites and other microbes that could cause potential harm to the mother and baby. While these infections are extremely rare, it is wise to avoid raw meat and fish. There is no safe limit of alcohol in pregnancy, complete avoidance is the best policy. Caffeine is safe in small quantities (1-2 caffeinated beverages daily). There is no scientific evidence that nutrasweet (aspartame) or other sugar substitutes are harmful in pregnancy.
Should I exercise?
Staying active is great for you and the baby. If you have an uncomplicated pregnancy you can continue your current exercise regimen with a few modifications. When doing cardiovascular exercise (walking, running, biking, elliptical trainer) a good guideline is to keep your heart rate at a maximum of about 140 beats per minute. This will allow blood flow to go to the uterus as well as your large muscles. If you are working out with weights, modify exercises that require you to be flat on your back or flat on your stomach after 12 weeks. Cut out abdominal exercises, they won’t be effective. If you are not a regular exerciser, walk for 20-30 minutes 3-5 times a week, and consider a prenatal yoga or pilates class. Occasionally complications such as bleeding, preterm labor or high blood pressure will prevent you from being able to exercise, but for most women regular exercise is a great way to prevent excessive weight gain, reduce stress, and keep the physical strength necessary to deliver and take care of a new baby.
Sex is safe in pregnancy unless you have complications such as bleeding, pre-term contractions or a low-lying placenta. While sex may make you have mild contractions, it will not make an otherwise healthy pregnant woman go into premature labor. Unless your doctor tell you otherwise, continue your normal sexual practices if you want to.
About hair dying:
Hair color is absolutely safe during pregnancy. Hair that is outside of the scalp is dead tissue and does not absorb anything into the bloodstream.
If you have an uncomplicated pregnancy it is safe to travel until you are likely to go into labor. We generally recommend staying close to home after 36 weeks, and not leaving the country after 26-28 weeks unless is absolutely necessary. Flying is safe in pregnancy but may increase your risk for blood clots, so wear support hose on long flights and move about the cabin once an hour. With long road trips make frequent rest stops to stretch your legs and maintain circulation.
Outdoor cats can be exposed to Toxoplasmosis and can pass this parasite to humans through the feces. One could acquire it by changing the litter box of an infected cat. If your cat goes outside, have someone else change the litter box when you are pregnant, or wear gloves and wash your hands well. If your cat lives inside and only eats processed cat food she cannot get the disease. Cuddling your cat is safe and will not expose you to the disease. Dogs are not affected. Toxoplasmosis can be harmful to a developing fetus but is very rarely seen in the USA.
About vitamins & supplements:
Folic acid is a B vitamin that has been shown to reduce the risk of spina bifida. 1 mg is recommended during the month prior to pregnancy and for the first 2 months after conception to reduce this risk. More folic acid may be recommended if you have family history of spina bifida. If you are not anemic and eat a well balanced diet, stopping prenatal vitamins (generally multivitamin with 1 mg of folic acid, as well as calcium and iron) at 2 months of pregnancy is acceptable. After 12 weeks the baby begins to make bone and will draw the necessary calcium from your bones. To prevent bone loss 1000-1500 mg of calcium is recommended —equates to 4-5 servings of milk, yogurt or dairy. Since this is difficult to consume, take a calcium supplement (usually 500-600 mg) to make up the difference. Don’t take calcium and iron (in the multivitamin) at the same time as they can offset each other’s absorption. If you eat fish 3 times weekly you are getting plenty of Omega-3 fatty acids, or Essential Fatty Acids (EFAs). If not, take a supplement containing 200mg of DHA (from fish oil or flax seed oil). There is a growing body of evidence that EFA deficiency may contribute to a number of pregnancy complications including preterm labor and pre-eclampsia. EFAs may help fetal eye and brain development, may improve mom’s skin, hair and nails and are also passed into the breast milk.
About ways to sleep:
When we lay on our back the large blood vessels that run close to our spine can be compressed by the pregnant uterus. In the third trimester this can decrease blood flow to the baby. At the same time, blood flow to your head will be decreased and you may feel dizzy and lightheaded. While there is no evidence that lying on your back sometimes is harmful, blood flow to the baby will be maximized if you tilt your abdomen even slightly to the left or the right. Assuming you have a normal healthy heart, either the right side or the left is fine. Before the third trimester most women can lie comfortably on their back as blood flow is not significantly affected.
How to I register at the hospital and take the tour?
You can register online at https://secure1.mhhs.org/previsit/members/preregister.asp, or simply walk from our office to the labor and delivery area of the hospital during business hours. Make sure you are registered a month before your due date. Registration takes a few minutes, and a nurse will usually have time to give you a quick tour. You can also schedule a formal tour by calling (713) 222-CARE.
After delivery, how long will I stay in the hospital?
After an uncomplicated vaginal delivery you can stay 24-48 hours. After an uncomplicated
C-section you may be ready to leave as soon as 48 hours, or as long as 96 hours. We see most of our patients 2 weeks after a C-section and 6 weeks after a vaginal delivery.
About my baby's doctor:
You will need a pediatrician with privileges at Memorial Hermann to see your baby before
discharge. If you do not have one already we will recommend some excellent doctors for you to consider. We recommend our patients to meet and interview your future baby's doctor before delivery. After discharge, the first visits with the pediatrician are usually at 2 weeks of life, and you can make this appointment as soon as the baby is born.
About childbirth classes:
Specially if this is your first baby, you may want to take a childbirth class. While this is not required, it may help you to be more comfortable about what to expect. Most parents take a class in the last 2-3 months of pregnancy. The hospital has a very good basic childbirth class that you can schedule by calling (713) 222-CARE. The class schedule is available at www.memorialhermann.org.
About dental care:
Routine dental work is safe during pregnancy and we encourage you to keep up with your
normal dental health routine. Most dentists will require a note from us saying that the visit is safe, and we can give you a standardized letter to take to your visit. If you need extensive dental work we can discuss the best options for medications with your dentist.
When should I call the doctor?
If you have a true emergency at night that cannot wait until the office reopens (if you are in labor, for example) our office number will prompt you to connect to an operator who will page the doctor on call. While we are always available in emergencies, we ask you to use your judgment and not disturb the doctors after hours with matters that can be dealt with the next business day.
Examples of reasons to call the emergency line (24 hours) in the first and second trimester include vaginal bleeding that is more than spotting, persistent cramping, any severe pain, fever higher than 101.0 F, or vomiting that is preventing fluid intake for more than 24 hours.
Examples of reasons to call the emergency line (24 hours) in the third trimester include leaking amniotic fluid (a persistent trickle or gush of watery fluid), vaginal bleeding that is more than spotting, decreased or absent fetal movement (at rest, you should feel at least 4 small movements in an hour), or regular, painful contractions. If you are 36 weeks or more, you have not had a C-section before, and your doctor is planning a vaginal delivery, call us when your contractions have been 5 minutes apart or less for at least an hour. If you are worried or not sure if you are in labor, it is always best to call. If you feel that you need to go to the hospital at any time, please call us first so that the doctor on call can advise you and let the hospital know that you are coming.
How does my insurance work?
Every insurance plan is different, it is important that you understand the way your policy works. Our staff will check on your policy/benefits and will be able to explain this to you when you arrive at your first visit. Most insurance companies pay us for the prenatal care (about 13 visits) as well as the delivery after you deliver. Usually you will have one co-pay for the whole package (global fee). If you have visits that are not related to normal prenatal care, these will be additional charges to your insurance and will have additional co-pays. Tests such as ultrasounds are billed separately and have separate co-pays. Most policies have a deductible or patient portion that you will be asked to pay before you deliver. The hospital will bill your insurance separately, as will other doctors at the hospital including the anesthesiologist and pediatrician. Remember that your doctor is a medical expert, not insurance expert. Please direct your insurance and billing questions to the front desk staff, not to your doctor.
What can I expect at my appointments?
If you have a normal pregnancy your scheduled visits will be monthly until 30 weeks, then every 2 weeks until 36 weeks, then weekly until delivery. At each visit we will record your weight and blood pressure, check your urine, listen to the baby’s heartbeat and assess the baby’s growth. Some appointments will include specific tests. A detailed ultrasound of the baby’s anatomy will be scheduled as a separate appointment between 20-22 weeks. 24-28 weeks- testing for gestational diabetes will be done. If your blood type is RH negative you will receive a shot of Rhogam at about 28 weeks. At the end of your pregnancy, your cervix will be checked weekly for dilation and effacement, and to make sure the baby’s head is down. We do our best to be on time for appointments, but occasionally the doctor is delayed at the hospital with deliveries or surgery, please bring a book to your appointments, as we cannot predict when this may happen. We will do your best to inform you of the delay if there is one. If you have no problems sometimes it may suffice to see the nurse, who can relay any questions to your doctor when he returns.
Since you are seen frequently, write your questions down and bring them to your next appointment. If you have more urgent questions, leave a message with your doctor’s nurse and you will get a reply by the end of the business day.